The Federal Assault: Understanding What Happened#

The federal government's attack on transgender healthcare began within hours of the second Trump inauguration. Executive Order 14168, titled "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government," established the ideological framework for everything that followed—a federal policy position that recognizes only binary sex assigned at birth and treats gender identity as illegitimate (White House, 2025). The executive order directed all federal agencies to implement this framework, and subsequent orders, regulations, and enforcement actions extended its reach into healthcare, documentation, military service, and federal employment.

Understanding the specific mechanisms of this assault matters because it clarifies what has actually changed, what legal challenges remain viable, and where protection still exists. The federal government's power is significant but not unlimited, and the picture—while grim—is more nuanced than the headlines suggest.

Section 1557 enforcement narrowed#

Section 1557 of the Affordable Care Act remains a federal nondiscrimination law for covered health programs. The June 2026 HHS notice says a federal court vacated the parts of the 2024 rule that treated gender identity as sex discrimination under Title IX; HHS says it will not enforce those vacated provisions.

The practical effect still matters, but a refusal of care is not automatically lawful. HHS says other Section 1557 protections remain in effect; state nondiscrimination law, insurance contracts, and the facts of a refusal may create additional rights. If you are refused care or coverage, ask for the reason in writing and seek a case-specific review before assuming no remedy exists.

Federal Employee Coverage Ended#

For plan year 2026, OPM Carrier Letter 2025-01b directs FEHB and Postal Service Health Benefits carriers to exclude surgical and hormonal sex-trait modification services regardless of age. The same letter requires coverage for counseling related to possible or diagnosed gender dysphoria and a case-by-case exceptions process for people already in a surgical or hormonal regimen. Ask your carrier for its 2026 plan brochure, the written exception criteria, and an appeal route; the exclusion does not mean every mental health service ended.

For someone whose long-standing treatment has depended on FEHB or PSHB coverage, an exclusion can mean urgent calls about prescriptions, appointments, and costs. Keep the 2025 and 2026 plan brochures, prior authorizations, pharmacy records, and denial letters together. The OPM letter requires carriers to explain their mid-treatment exception process in the brochure; request a written determination for your own regimen. A denial may be appealable. Keep the names and numbers of people who can help you navigate the next decision.

Military Service Ban Reinstated#

Executive Order 14183, signed on January 21, 2025, reinstated a ban on transgender military service. Active-duty service members were given 90 days to either "revert" to their assigned sex at birth or face discharge. The Pentagon estimated this affected approximately 15,000 active service members (DOD, 2025). In May 2025, the Supreme Court allowed the ban to take effect while litigation continued, extending the precedent established in the first Trump administration's military ban.

VA Restrictions on New Patients#

The VA's March 17, 2025 notice rescinded its prior transgender and intersex care directive. It permits VA hormone treatment for veterans already receiving it through VA on the notice date and for some people whose treatment began during military service before separation; it says veterans outside those categories are not eligible for that hormone treatment through VA. The notice also says VA does not provide other medical or surgical treatment for gender dysphoria, while preventive and mental health care continue. Ask the VA team for a written decision about your own treatment history and current options.

Passport and Documentation Freezes#

The State Department's current sex-marker page says it issues new U.S. passports only with M or F matching its determination of sex at birth and no longer issues X markers. The page also says existing passports remain valid until expiration, replacement, or invalidation under federal regulations. It warns that requesting a different marker may delay an application and that some destinations may restrict travel with X; check the destination and your specific document before booking.

The Social Security Administration's June 2026 operating instruction says it corrects or changes the sex field in its NUMIDENT record only to reflect sex at birth, with specified evidence. An existing record and a new request can have different consequences. If your records conflict, ask SSA for its current written determination and the available review process. Processing depends on the current instruction and your record.

CBP and Airline Systems#

If your identity documents or reservation details differ, contact the airline before travel and carry the documents it asks for. The claimed October 2025 APIS binary-only change and automatic conversion of X to M were not confirmed in a CBP primary source. For U.S. airport screening, consult TSA's current acceptable-ID list; for international documents, consult the State Department's passport page and the destination's entry rules. A valid passport, an acceptable checkpoint ID, and a destination's admission decision are distinct questions.

For travel, check the document rules at the time of the trip. The State Department says an existing passport remains valid unless it expires, is replaced, or is invalidated, while a replacement will follow its current marker policy. Keep copies of your documents and confirm airline and destination requirements directly. Whether or when to renew is a personal decision shaped by expiration date, travel need, and legal advice; this page cannot give a universal instruction.

CMS actions: a final funding rule and a separate hospital proposal#

CMS announced a final Medicaid and CHIP funding rule on August 11, 2026 concerning specified care for children and youth; CMS schedules it to take effect October 13, 2026. It applies to federal Medicaid and CHIP funding for the specified pediatric services, not to Medicare coverage for all ages. Separately, CMS announced a December 2025 hospital participation proposal concerning specified procedures for patients under 18. The two actions have different legal mechanisms and age thresholds.

As of September 26, 2026, the Medicaid and CHIP rule has been finalized but its scheduled effective date has not arrived. CMS says the final action concerns federal funding, allows a limited hormone taper period for children already on treatment, and does not affect mental health service coverage. The hospital measure cited above was announced as a proposal; confirm its latest docket status before describing it as in force. The February 2026 public-comment deadline is past.

Do not assume a national rule answers your own coverage question. The CMS final-rule announcement is limited to federal Medicaid and CHIP funding for specified youth care; it does not itself establish an all-ages ban or describe every state payment decision. Ask your plan and treating team for written, procedure-specific coverage and timing, particularly if care is scheduled near the effective date. Legal challenges or later agency action may change the position.

If you want to challenge or track one of these actions, start with the published CMS final-rule notice and the separate hospital proposal announcement, then check the current docket and court orders. Check whether a comment period is still open before preparing a submission. Community advocacy remains possible, but it needs the correct rule, deadline, and record.

The Supreme Court's Skrmetti Decision#

On June 18, 2025, the Supreme Court ruled 6-3 in United States v. Skrmetti that Tennessee's ban on gender-affirming care for minors did not violate the Equal Protection Clause of the Fourteenth Amendment (United States v. Skrmetti, 2025). Chief Justice Roberts wrote for the majority that Tennessee's law SB1 does not classify based on sex or transgender status but rather on age and medical purpose, and therefore requires only "rational basis" review—the most deferential standard of constitutional scrutiny.

The decision was devastating for transgender youth in states with existing bans and immediately foreclosed the primary legal strategy that advocates had been pursuing to challenge state restrictions on youth care. By August 2025, following the decision, 27 states had enacted bans on gender-affirming care for minors that remained in effect, with only Montana's ban still blocked by court order based on state constitutional claims (Movement Advancement Project, 2026; KFF, 2025).

However, understanding the decision's actual scope is critical for strategic planning. The Supreme Court explicitly declined to reach several questions that remain open for future litigation:

First, the Court did not decide whether transgender people constitute a "suspect class" or "quasi-suspect class" entitled to heightened constitutional protection. Favorable circuit court precedents on this question remain in place and can still be invoked in future cases with different fact patterns (Lambda Legal, 2025).

Second, the Court did not address due process claims based on parental rights to make medical decisions for their children. The Arkansas ban challenge, which included due process claims, resulted in a permanent injunction that remains in effect precisely because it was not decided solely on equal protection grounds (KFF, 2025).

Third, the Court expressly limited its holding to the specific Tennessee law and record before it. Justice Roberts noted that the decision did not extend to laws that show discriminatory intent or animus—leaving open challenges to laws enacted or enforced with overt hostility toward transgender people, which the Trump administration's public statements arguably provide.

Fourth, the decision says nothing about adult care. State restrictions on adult healthcare access raise different constitutional questions and have not been ruled upon by the Supreme Court.

The State Department's passport policy page says the Supreme Court stayed a preliminary injunction in Orr v. Trump on November 6, 2025; the department consequently resumed issuing new passports according to its sex-at-birth marker policy. That interim order does not resolve every challenge to federal documentation policy. Check the current case and agency instructions before a new application.

State Shield Laws: The Geography of Protection#

State shield measures respond to cross-border attacks on lawful care, but their number and scope change. The Movement Advancement Project's live policy map is a starting index, not a substitute for the statute and current court orders in the states involved. Some protections cover adult care, some youth care, some records or professional licenses, and some are limited by litigation. Check the law that applies to the patient, provider, and service before relying on a shield.

Shield laws typically provide four categories of protection. They prohibit state cooperation with out-of-state investigations or subpoenas related to gender-affirming care that is legal in the shield state. They block extradition of individuals for alleged crimes related to receiving or providing such care. They protect medical providers from having their licenses suspended or revoked for providing legal care to patients who reside in hostile states. And they shield providers and patients from civil liability arising from out-of-state lawsuits related to gender-affirming care.

The strength and scope of these protections varies significantly by state. California's SB 107, enacted in 2022, allows California courts to take emergency custody jurisdiction if a child is at risk of being removed from their parents for supporting gender-affirming care—a provision designed specifically to protect families fleeing hostile states (CA Sen. Bill 107, 2022). California also prohibits state healthcare providers and insurers from complying with out-of-state subpoenas or search warrants related to gender-affirming care without a California court order under AB 1194 (CA Assembly Bill 1194, 2023).

Illinois' HB 4234 includes explicit anti-extradition language and prohibits Illinois-based insurance companies from sharing claims data with out-of-state entities when requests relate to lawful gender-affirming care (IL HB 4234, 2023). New York's S.4516 not only shields providers and patients but prohibits New York financial institutions from complying with out-of-state civil judgments related to gender-affirming care (NY S.4516, 2023).

A shield law can limit what its own state does with out-of-state requests, but it does not automatically authorize every cross-state telehealth visit or prescription. Licensure, prescribing rules, patient location, and the exact state statute still matter. If you rely on telehealth, ask the provider which license and rule cover care delivered where you physically are. Do not assume a provider in another state can legally treat you remotely.

The shield states with the strongest combined protections—comprehensive shield laws, Medicaid coverage for gender-affirming care, state employee health insurance coverage, and established networks of affirming providers—include California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Vermont, and Washington. If you are considering relocation, these states offer the most robust legal and practical infrastructure for transgender healthcare access.

Hospital Closures and Provider Retreat#

The federal assault created exactly the chilling effect it was designed to create. Major medical institutions across the country have shut down or restricted transgender care programs, citing legal risks and threats to federal funding. By August 2025, at least 21 hospitals had ended or restricted gender-affirming care for minors (NBC News, 2025).

Children's Hospital Los Angeles closed its Center for Transyouth Health and Development—one of the oldest and largest youth gender clinics in the country—in July 2025, citing "an immediate and unsustainable strain on our fiscal resiliency" created by federal funding threats (LA Public Press, 2025). The closure affected approximately 3,000 active patients who had to find new providers. Children's National Hospital in Washington, D.C. announced it would stop prescribing puberty blockers and hormone therapy for transgender youth patients, pointing directly to executive orders and subsequent enforcement actions (Children's National, 2025).

The cascade continued. Lurie Children's Hospital in Chicago stopped performing transition-related surgeries on minors. NYU Langone Health reportedly ceased some gender-affirming surgical services. Kaiser Permanente announced a pause on surgical treatment for patients under 19 across its system. Nationwide Children's Hospital in Columbus, Ohio went further than most, announcing in September 2025 that it would end all gender-affirming care for all patients—including adults and those grandfathered under state law—by September 26, 2025 (WOSU, 2025).

In July 2025, the Department of Justice issued subpoenas to more than 20 hospitals and clinics providing gender-affirming care to youth, announcing investigations for healthcare fraud, false statements, and other potential criminal violations (Fox News, 2025). This was explicit intimidation. The message was clear: provide this care and face federal investigation.

Some institutions have refused to capitulate. Boston Children's Hospital's GeMS program affirmed it would continue operations. Mount Sinai in New York publicly committed to maintaining transgender care services. But the overall effect has been a dramatic contraction in available providers, particularly for youth care in states without explicit legal protections.

For adults seeking genital surgery, the picture is somewhat more stable—established adult gender surgery programs at academic medical centers have generally continued operating, though waitlists have lengthened as capacity has failed to keep pace with demand. Dr. Jens Berli at OHSU continues to have a 12-18 month waitlist for initial consultation. Mount Sinai in New York claims no waitlist for some procedures. Mayo Clinic in Minnesota reports 5-7 month waits for initial appointments. These programs exist in shield states or states with strong non-discrimination protections, and they have the institutional resources and legal infrastructure to continue despite federal hostility.

Survival Strategies: Practical Steps for Different Situations#

The strategic landscape depends heavily on where you live and what care you need. What follows are situation-specific approaches drawing on the most current legal guidance and provider information available.

If You Are in a Shield State#

You have significant legal protection, but you should not take it for granted. Political winds shift—what is protected today could be threatened tomorrow if state-level politics change.

Establish care now if you have not already. Even if you are not ready for surgery, having a documented treatment relationship with an affirming provider creates legal protection and continuity of care. Get on surgical waitlists if you are planning procedures; 12-18 month waits mean that action taken today positions you for care in mid-2027.

Document everything. Keep copies of all prescriptions, lab results, therapy notes, and surgical records—both physical copies and encrypted digital backups. Create a "care continuity binder" with your complete medical history, medication list with dosages and prescribing information, and contact details for all your providers. If you need to relocate suddenly or change providers, this binder becomes your lifeline for continuity.

Understand your specific state's protections. Each shield law is different. California's SB 107 provides emergency jurisdiction for children but does not automatically provide financial assistance. Colorado's HB 1039 includes anti-extradition language but does not prohibit private lawsuits from being filed. Read your state's actual statute or consult with local LGBTQ+ legal organizations to understand exactly what protection you have and what its limits are.

If You Are in a Hostile State#

This is the hardest situation, but you have more options than you might think.

Telehealth from shield state providers is legal. Federal law does not prohibit receiving medical care across state lines, whether physically or virtually. Multiple telehealth platforms specifically serve patients in hostile states by basing their operations in shield states and extending care under those protections:

Plume operates in 43 states, charges $99 per month on a subscription model, and requires no insurance. They explicitly operate under shield law protections and serve patients in hostile states (getplume.co).

FOLX Health serves 47 states, offers self-pay at approximately $39.99 monthly for their basic plan, and accepts insurance in some states. They have affirmed continued service to patients in states with bans (folxhealth.com).

QueerDoc provides sliding-scale telehealth services for hormone therapy and mental health, explicitly serving patients in hostile states (queerdoc.com).

Getting the prescription is half the challenge; filling it is the other half. Mail-order pharmacies including Capsule, Alto, and some compounding pharmacies will ship hormone therapy to hostile states with valid prescriptions from licensed providers. Strohecker's Pharmacy in Oregon specifically serves transgender patients and ships nationwide (stroheckersrx.com). However, some pharmacies in hostile states have refused to fill valid prescriptions—if this happens, document the refusal in writing and file complaints with both your state pharmacy board and attorney general, as refusal to fill a valid prescription without legitimate cause typically violates pharmacy regulations.

Travel to nearby shield states for in-person care may be feasible depending on your location. Planned Parenthood clinics in shield states provide hormone therapy on an informed consent basis regardless of where you live. Academic medical centers in shield states will accept patients from other states for surgical consultation and procedures.

If You Are Considering Relocation#

Relocation is not a decision to take lightly, but for some people it is the safest and most practical long-term option.

The states with the strongest combined protections—shield laws, Medicaid coverage, state employee insurance coverage, employment non-discrimination protections, and established trans communities with robust provider networks—include California, Colorado, Illinois, Massachusetts, Minnesota, New York, Oregon, Vermont, and Washington.

Organizations providing relocation assistance have seen demand surge since January 2025:

Trans Continental Pipeline (tcpipeline.org) is a national mutual aid network connecting transgender people in hostile states with housing, employment leads, and medical care connections in shield states.

Project Open Arms, based in Minnesota (tractionpnw.org/open-arms), provides financial assistance and housing placement for transgender individuals and families relocating to Minnesota. They report waitlists of six months or longer due to overwhelming demand.

A Place for Marsha connects transgender individuals facing housing instability with temporary and longer-term housing options.

Elevated Access provides free flights for patients traveling to access healthcare including gender-affirming care.

If you are considering relocation, start planning immediately. Housing and employment searches take time, and the organizations providing assistance are stretched thin. Document your skills and experience, research job markets in destination states, and make contact with local transgender community organizations before you move.

Insurance Navigation and Deadlines#

Check the current Marketplace enrollment window#

The January 15, 2026 Marketplace deadline has passed. HealthCare.gov's dates page says the next federal Marketplace open-enrollment window begins November 1 for 2027 coverage; outside open enrollment, a person may qualify for a Special Enrollment Period after an eligible life event or other listed circumstance. State marketplaces can have their own dates. Confirm the available window and the plan's exact benefits before switching coverage.

Out2Enroll can help you compare LGBTQ+ coverage questions, but confirm current enrollment dates and eligibility through HealthCare.gov or your state Marketplace. Ask each plan in writing about the exact procedure, provider network, exclusions, prior authorization, and appeal steps; a plan's state location alone does not guarantee payment.

Appealing Insurance Denials#

Even in shield states with coverage mandates, insurers test boundaries. When you receive a denial, you have options.

Document your care according to WPATH Standards of Care, Version 8 (Coleman et al., 2022). The Standards remain the international clinical framework for medical necessity in gender-affirming care. When appealing a denial, cite specific SOC 8 criteria and have your provider document how your requested care meets established clinical guidelines.

Check the current insurance rule for your state and plan type. The Movement Advancement Project map helps locate state policies, but a coverage mandate may have exceptions and may not govern a self-funded employer plan. If your insurer denies a claim, ask it to identify the exclusion or medical-necessity criterion in writing and compare that reason with the governing policy and state regulator's guidance. State lists change, and your plan type matters.

Follow the formal appeal process and the deadline in your own denial letter. HealthCare.gov explains internal and external review, including the federal external-review filing period and possible expedited review; state or plan rules can differ. Submit medical-necessity documentation and request a written decision. An external review is not always free, so check the stated fee and whether a state consumer-assistance program can help.

Digital Privacy and Operational Security#

If you are accessing care across state lines or live in a hostile state, your digital footprint is a vulnerability.

Use end-to-end encrypted messaging for any discussions of healthcare plans. Signal is the gold standard—messages are encrypted and Signal stores minimal metadata. Do not discuss your care via standard SMS, email, or social media direct messages.

Audit your social media. Law enforcement and hostile family members have used social media posts as evidence in custody battles and investigations. Scrub posts that explicitly reference gender-affirming care plans. Set accounts to private. Understand that even "private" posts can be subpoenaed from platforms including Facebook, Instagram, and TikTok.

Request information about your provider's records disclosure policies. Some shield states, including California under AB 1194, prohibit healthcare providers from complying with out-of-state subpoenas or warrants related to gender-affirming care without a local court order. Ask your provider whether they are covered by such protections and how they handle out-of-state requests for patient information.

The Electronic Frontier Foundation (eff.org) publishes comprehensive digital security guides, including resources specifically addressing privacy for reproductive and gender-affirming care. Review their materials and implement two-factor authentication on all accounts, use a password manager, and consider the privacy implications of location data on your phone and in apps.

Lambda Legal (lambdalegal.org) is the primary legal organization fighting for LGBTQ+ rights in court. Their legal helpline is 800-528-6257.

Transgender Law Center (transgenderlawcenter.org) provides policy advocacy and direct legal services specifically focused on transgender rights. Their helpline is 415-865-0176.

National Center for Lesbian Rights (nclrights.org) provides legal advocacy with particular strength in family law and custody issues.

ACLU's LGBTQ & HIV Project (aclu.org/lgbt-rights) coordinates nationwide litigation on transgender rights.

Crisis Support#

Trans Lifeline (877-565-8860) is a peer support hotline staffed by transgender people for transgender people.

The Trevor Project (1-866-488-7386; text START to 678-678) provides crisis support for LGBTQ+ youth ages 13-24.

988 Suicide and Crisis Lifeline provides immediate crisis support for anyone in distress.

Financial Assistance#

Point of Pride (pointofpride.org) offers financial assistance for hormone therapy, surgery, and chest binders—now the primary grant resource after absorbing the Jim Collins Foundation.

For The Gworls (forthegworls.party) is a mutual aid fund focused on Black transgender people.

Trans Lifeline Microgrants (translifeline.org) provides small emergency grants for transgender individuals in crisis.

See U.S. Insurance, Costs, and Documents for comprehensive grant program details and application guidance.

What Comes Next#

As of September 2026, federal and state policies affecting transgender care are changing quickly. HHS's Section 1557 notice and CMS's August final-rule announcement show why policy status must be checked against the current measure and court orders. The stakes are personal and immediate, and the attacks are real; readers also need the exact agency action, age group, program, effective date, and current court status to act on a claim.

And yet.

States and community organizations continue to defend access. Shield laws, coverage rules, and litigation have different effects in different places; use the current state policy map to begin research and then read the applicable statute or order. The Skrmetti decision did not decide every adult-care or federal-policy question. People pursuing care deserve a pathway grounded in the rule that actually governs them.

Providers who refuse to abandon us continue to operate. The telehealth providers serving patients in hostile states are performing an act of resistance. The academic medical centers in shield states that have publicly committed to maintaining transgender care are taking a stand. The primary care physicians quietly continuing to prescribe hormone therapy in states without explicit bans are providing essential care in the face of federal threats.

Mutual aid networks have expanded dramatically. The organizations helping people relocate, access care, and survive this moment are doing work that the government has made necessary and that the community has made possible.

This guide needs review whenever a policy, court order, plan year, or provider pathway changes. The durable work is to save written decisions, check dates on original sources, build a support network, and keep a realistic care and backup plan. Community knowledge helps people find the questions to ask and the people who can stand beside them.

They want us to disappear. We will not.

Reflection Questions#

  1. Review your current documentation—passport, birth certificate, driver's license, Social Security card. Which documents accurately reflect your identity, and which could benefit from updating while such changes remain available? What is your strategy for managing documents that cannot currently be changed?

  2. If you are in a hostile state: What telehealth, travel, or relocation options are realistically available to you given your circumstances? What resources, financial support, or practical help would you need to pursue them? Who could you ask for help?

  3. If you are in a shield state: Have you taken full advantage of the protections available? Have you established documented care relationships, secured your medical records, and connected with local transgender community organizations? What remains undone?

  4. Who is in your support network right now? If you needed emergency housing, transportation to a medical appointment, or help navigating a crisis, who would you call? If the answer is unclear, what steps can you take to build or strengthen that network?

  5. How are you protecting your mental health while navigating this landscape? What boundaries do you need around news consumption, social media, and political engagement? What practices or relationships sustain you?

References#

American College of Physicians. (2026). Attacks on gender-affirming and transgender healthcare. https://www.acponline.org/advocacy/state-health-policy/attacks-on-gender-affirming-and-transgender-health-care

California Assembly Bill 1194. (2023). Healthcare: Medical information: Gender-affirming care. CA Legis. Assemb. Bill No. 1194. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB1194

California Senate Bill 107. (2022). Family law: Gender identity. CA Legis. Sen. Bill No. 107. https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB107

Centers for Medicare & Medicaid Services. (2026, August 11). CMS ends federal Medicaid and CHIP funding for specified procedures for children and youth [Final rule announcement; scheduled effective date October 13, 2026]. https://www.cms.gov/newsroom/press-releases/cms-ends-federal-medicaid-chip-funding-sex-rejecting-procedures-children-youth

Children's National Hospital. (2025). Statement on executive order. https://www.childrensnational.org/about-us/newsroom/2025/statement-on-executive-order

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L., Deutsch, M. B., ... & Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health, 23(S1), S1-S259. https://doi.org/10.1080/26895269.2022.2100644

Department of Defense. (2025). Policy memorandum: Military service by transgender persons. Office of the Under Secretary of Defense for Personnel and Readiness.

Department of State. (2026, March 16). Sex markers in passports. U.S. Department of State, Bureau of Consular Affairs. https://travel.state.gov/en/passports/apply/unique-needs/sex-markers.html

HealthCare.gov. (n.d.). When can you get health insurance? https://www.healthcare.gov/quick-guide/dates-and-deadlines/

HealthCare.gov. (n.d.). Special enrollment periods for complex health care issues. https://www.healthcare.gov/sep-list/

HealthCare.gov. (n.d.). External review. https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

Human Rights Watch. (2025, September 9). Trump moves to restrict gender-affirming care to federal workers, families. https://www.hrw.org/news/2025/09/09/trump-moves-to-restrict-gender-affirming-care-to-federal-workers-families

Illinois House Bill 4234. (2023). Gender-affirming care protection. IL Legis. H.B. 4234. https://www.ilga.gov/legislation/BillStatus.asp?DocNum=4234&GAID=17&DocTypeID=HB&SessionID=112&GA=103

Kaiser Family Foundation. (2025a). Overview of President Trump's executive actions impacting LGBTQ+ health. https://www.kff.org/other-health/overview-of-president-trumps-executive-actions-impacting-lgbtq-health/

Kaiser Family Foundation. (2025b). What are the implications of the Skrmetti ruling for minors' access to gender-affirming care? https://www.kff.org/lgbtq/what-are-the-implications-of-the-skrmetti-ruling-for-minors-access-to-gender-affirming-care/

Lambda Legal. (2025). Proud & free: United for trans power in the wake of U.S. v. Skrmetti. https://lambdalegal.org/us-v-skrmetti-faq/

Lambda Legal. (2026). Know your rights: Trans travel in 2026. Lambda Legal Defense and Education Fund.

Movement Advancement Project. (2026). Equality maps: Healthcare laws and policies. https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies

NBC News. (2025, August 24). At least 21 hospitals have ended or restricted trans care for minors since January. https://www.nbcnews.com/nbc-out/out-news/least-21-hospitals-ended-restricted-trans-care-minors-january-rcna226640

New York Senate Bill 4516. (2023). Gender-affirming care shield act. NY Legis. Sen. Bill No. S.4516.

NPR. (2025, December 18). Transgender youth face national ban on medical care under new hospital rules. https://www.npr.org/sections/shots-health-news/2025/12/18/nx-s1-5647789/transgender-gender-affirming-care-rfk-jr-dr-oz-trump

Office of Personnel Management. (2025, August 15). Carrier Letter 2025-01b: Chemical and surgical sex-trait modification services for plan year 2026 proposals. U.S. Office of Personnel Management. https://www.opm.gov/healthcare-insurance/carriers/fehb/2025/2025-01b.pdf

Social Security Administration. (2026, June 5). POMS RM 10212.200: Changing NUMIDENT data for reasons other than name change. https://secure.ssa.gov/poms.nsf/lnx/0110212200

U.S. Office of Personnel Management. (n.d.). FEHB plan information for 2026. https://www.opm.gov/healthcare-insurance/healthcare/plan-information/plans/

Transgender Legal Defense & Education Fund. (2026). Know your rights: Traveling while trans in 2026. https://transgenderlegal.org/travel-rights-2026

Transportation Security Administration. (n.d.). Acceptable identification at the TSA checkpoint. https://www.tsa.gov/travel/security-screening/identification

U.S. Department of Health and Human Services. (2025, December 18). HHS acts to bar hospitals from performing specified procedures on children [Proposed hospital condition of participation]. https://www.cms.gov/newsroom/press-releases/hhs-acts-bar-hospitals-performing-sex-rejecting-procedures-children

U.S. Department of Health and Human Services. (2026, June 1). HHS informs covered entities of partial vacatur of 2024 ACA nondiscrimination final rule. https://www.hhs.gov/press-room/informs-covered-entities-partial-vacatur-2024-aca-nondiscrimination-final-rule-tennessee-v-kennedy.html

U.S. Department of Veterans Affairs. (2025, March 17). VHA Notice 2025-01(1): Rescission of VHA Directive 1341(4), providing health care for transgender and intersex veterans. Veterans Health Administration. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=12188

United States v. Skrmetti, 605 U.S. 495 (2025). https://www.supremecourt.gov/opinions/24pdf/23-477_2cp3.pdf

White House. (2025). Executive Order 14168: Defending women from gender ideology extremism and restoring biological truth to the federal government. https://www.whitehouse.gov/presidential-actions/

Williams Institute, UCLA School of Law. (2025). Shield laws for reproductive and gender-affirming healthcare: A state law guide. https://williamsinstitute.law.ucla.edu/publications/shield-laws-fact-sheets/

WOSU Public Media. (2025, September 5). Nationwide Children's Hospital ending all gender-affirming care for trans patients by Sept. 26. https://www.wosu.org/politics-government/2025-09-05/nationwide-childrens-hospital-ending-all-gender-affirming-care-for-trans-patients-by-sept-26

Continue exploring#